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Guidelines for nutrition support in chronic wounds
No full textKroničnim ranama smatraju se rane različitih etiologija koje ne cijele u vremenskom razdoblju od šest do osam tjedana. U bolesnika s kroničnom ranom normalna fiziologija linearnog cijeljenja pretvara se u patološki kronični ciklus „začaranog kruga“, bez jasne krajnje točke zatvaranja rane. Proces cijeljenja rane može biti narušen brojnim čimbenicima sistemnog i lokalnog karaktera. Suvremeni pristup bolesniku s kroničnom ranom zahtijeva interdisciplinarni pristup s obzirom na različitu etiologiju nastanka rane. Malnutricija može usporiti cijeljenje rane i povećati opasnost kroničnog tijeka unatoč modernim lokalnim tehnikama. Štoviše, prisutnost upalnog odgovora povezanog s kroničnom ranom povećava gubitak stanične mase tijela i uzrokuje anaboličku rezistenciju. Nutritivni status bolesnika igra ključnu ulogu u cijeljenju rane, a poseban značaj pridaje se adekvatnom unosu energije, proteina, specifičnih esencijalnih i uvjetno esencijalnih nutrijenata te hidraciji bolesnika. Preporučen energijski unos pothranjenih bolesnika u riziku od kroničnih rana i dekubitalnih ulkusa iznosi 30 – 35 kcal/kg/dan, a pritom
je preporučeni unos proteina 1,2 – 1,5 g/kg/dan. Te preporuke su okvirne i trebaju se prilagođavati za svakog bolesnika, ovisno o dobi, statusu uhranjenosti, komorbiditetima, stupnju, veličini i broju rana te bubrežnoj funkciji. Prepoznati su i neki specifični nutrijenti koji sudjeluju u procesu cijeljenja rane, poglavito proteini, glutamin, arginin, HMB, cink, selen, bakar, željezo te vitamini A, C i D. Cilj je ovih smjernica prikazati preporučeni algoritam probira i praćenja te uvođenja specifične nutritivne terapije u bolesnika s kroničnim ranama. U smjernicama su dodatno prikazane i specifičnosti nutritivne terapije kod opeklina, kirurških rana, dijabetičkog stopala te osobitosti neuroloških i gerijatrijskih bolesnika.Chronic wounds are wounds of various etiologies that do not heal within a period of 6–8 weeks. In patients with a chronic wound, the normal physiology of linear healing turns into a pathological chronic cycle of “vicious circle”, without a clear endpoint of wound closure. The wound healing process can be impaired by numerous factors, both systemic and local. The modern approach to the patient with a chronic wound requires an interdisciplinary approach considering the different etiologies of the wound. Malnutrition can slow wound healing
and increase the risk of a chronic course despite modern local techniques. Moreover, the presence of an inflammatory response associated with a chronic wound increases the loss of body cell mass and causes anabolic resistance. The nutritional status of the patient plays a key role in wound healing, and special importance is given to the adequate intake of energy, protein, specific essential and conditionally essential nutrients, and hydration of the patient. The recommended energy intake of malnourished patients at risk of chronic wounds and decubital ulcers is 30–35 kcal/kg/day, while the recommended protein intake is 1.2–1.5 g/kg/day. These recommendations are general and should be adjusted for each patient, depending on age, nutritional status, comorbidities, degree, size and number of wounds and kidney function. Some specific nutrients that participate in the wound healing process have been recognized, especially proteins, glutamine, arginine, HMB, zinc, selenium, copper, iron and vitamins A, C and D. The aim of these guidelines is to present a recommended screening and monitoring algorithm and to introduce a specific nutritional therapy in patients with chronic wounds. The guidelines also show the specifics of nutritional therapy for burns, surgical wounds, diabetic foot, and special approach to neurological and geriatric patients
Case report: Rapid-onset parkinsonism after a hornet sting
No full textNeurological manifestations with basal ganglia involvement following
stings are rare and clinically ill-defined conditions. We present a patient with acute parkinsonism non-responsive to levodopa, who developed striatal lesions after a hornet sting. We report his response to immunomodulatory treatment and subsequent clinical and brain magnetic resonance imaging (MRI) follow-up. We also searched the literature for patients with acute extrapyramidal syndromes following an insect sting. Fourteen cases have been published; 12 of them are reviewed here. The majority of cases presented with symmetric akinetic syndrome with axial rigidity and/or gait impairment. Six patients were treated with levodopa and only two of these had a modest response to therapy. Brain MRI/computed tomography scan revealed lesions of the basal ganglia, which resulted in fatal outcome in four patients, whereas only one achieved complete recovery. Clinicians should be aware of this rare but devastating cause of acute-onset parkinsonism and specific clinical presentation of this condition, and should consider prompt and prolonged immunomodulatory treatment to prevent irreversible basal ganglia damage
Validation of Contrast-Enhanced Mammography as Breast Imaging Modality Compared to Standard Mammography and Digital Breast Tomosynthesis
No full textContrast-enhanced mammography (CEM) is a relatively new imaging technique that allows morphologic, anatomic and functional imaging of the breast. The aim of our study was to validate contrast-enhanced mammography (CEM) compared to mammography (MMG) and digital breast tomosynthesis (DBT) in daily clinical practice. This retrospective study included 316 consecutive patients who underwent MMG, DBT and CEM at the Centre for Prevention and Diagnosis of Chronic Diseases of Primorsko-goranska County. Two breast radiologists independently analyzed the image data, without available anamnestic information and without the possibility of comparison with previous images, to determine the presence of suspicious lesions and their morphological features according to the established criteria of the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The diagnostic value of MMG, DBT and CEM was assessed by ROC analysis. The interobserver agreement was excellent. CEM showed higher diagnostic accuracy in terms of sensitivity and specificity compared to MMG and DBT, the reporting time for CEM was significantly shorter, and CEM findings resulted in a significantly lower proportion of equivocal findings (BI-RADS 0), suggesting fewer additional procedures. In conclusion, CEM achieves high diagnostic accuracy while maintaining simplicity, reproducibility and applicability in complex clinical settings
Retrospective analysis of the association between non-alcoholic fatty liver disease and breast cancer
No full textNealkoholna masna bolest jetre (NAFLD), razvila se od relativno nepoznate bolesti do najčešćeg uzroka kronične bolesti jetre širom svijeta. Karcinom dojke obuhvaća skupinu bolesti sa specifičnim histopatološkim, molekularnim i kliničkim svojstvima, s različitim kliničkim nalazima i odgovorima na liječenje, te s više entiteta. Oko dvije trećine karcinoma dojke je pozitivno na hormonske receptore (izražava estrogenske receptore, progesteronske receptore ili oba) i podložno je liječenju hormonalnim terapijama kao što su tamoksifen i inhibitori aromataze.
Cilj ovog rada bio je ispitati utjecaj hormonske terapije karcinoma dojke na razvoj komponenti metaboličkog sindroma, jednog od glavnih prekursora razvoja NAFLD-a kod pacijentica oboljelih od karcinoma dojke. Koristeći tranzijentnu elastografiju, prikazati utjecaj hormonske terapije na razvoj steatoze i fibroze jetre. Proučavani su i učinci terapije na razvoj inzulinske rezistencije (HOMA-IR bodovni sustav) te promjene u sastavu tijela definirane BIA vagom.
U ovu retrospektivnu studiju uključeno je 115 pacijentica onkološke ambulante Kliničkog bolničkog centra Rijeka, prosječne dobi od 64 godine, koje su bile podvrgnute hormonskoj terapiji s potpunom blokadom proizvodnje estrogena. Za mjerenja se koristio FibroScan® i BIA vaga. Bolesnicima je rađena i analiza krvi.
Provedena studija potvrđuje dosadašnje stavove i upotpunjuje dosadašnja istraživanja o razvoju NAFLD-a u bolesnica koje primaju hormonsko liječenje karcinoma dojke. Terapija tamoksifenom je značajno povezana s rizikom razvoja NAFLD-a, iako prognostička važnost tamoksifen-induciranog NAFLD-a na ishod i preživljenje nije dovoljno istražena. Ovim radom pokazujemo da inhibitori aromataze također imaju statistički značajnu povezanost s razvojem NAFLD-a.Nonalcoholic fatty liver disease (NAFLD) has evolved from a relatively unknown disease to the most common cause of chronic liver disease worldwide. Breast cancer comprises a group of diseases with specific histopathological, molecular and clinical characteristics, with different clinical findings and responses to treatment, and with multiple entities. About two-thirds of breast cancers are hormone receptor-positive (estrogen receptors expression, progesterone receptors expression or both) and are susceptible to treatment with hormonal therapies such as tamoxifen and aromatase inhibitors.
The aim of this study was to examine the impact of hormone therapy for breast cancer on the development of components of metabolic syndrome, one of the main precursors of the development of NAFLD in patients with breast cancer. Using transient elastography, the study shows the influence of hormone therapy on the development of steatosis and liver fibrosis. The effects of therapy on the development of insulin resistance (HOMA-IR scoring system) and changes in body composition defined by the BIA scale were also studied.
In this retrospective study, 115 patients of the oncology outpatient clinic of the Rijeka Clinical Hospital Center, with an average age of 64, were included, who were subjected to hormone therapy with a complete blockage of estrogen production. FibroScan® and BIA scales were used for measurements. Blood analysis was also performed on the patients. The conducted study confirms previous views and completes previous research on the development of NAFLD in patients receiving hormonal treatment for breast cancer. Tamoxifen therapy is significantly associated with the risk of developing NAFLD, although the prognostic significance of tamoxifen-induced NAFLD on outcome and survival has not been sufficiently investigated. In this study, we have shown that aromatase inhibitors also have a statistically significant association with the development of NAFLD
Invasive alien animal species in Croatia
No full textOvaj rad pod naslovom „Invazivne strane životinjske vrste u Hrvatskoj" fokusira se na ekološke i gospodarske učinke invazivnih stranih vrsta unesenih u Hrvatsku, namjerno ili slučajno. Invazivne vrste, koje uključuju kukce, sisavce, ribe, rakove, gmazove i ptice, brzo se prilagođavaju i šire zbog nedostatka prirodnih predatora, ugrožavajući lokalnu biološku raznolikost i narušavajući ekosustave.
Raznolika staništa u Hrvatskoj, od šuma, rijeka i jezera do obalnih i planinskih područja, pružaju povoljne uvjete za nove vrste. Raznolika klima Hrvatske kao i klimatske promjene dodatno pogoduju njihovom opstanku i širenju. Širenju invazivnih stranih vrsta doprinose i ljudske aktivnosti poput trgovine, turizma i transporta, pri čemu su luke poput one u Rijeci značajne ulazne točke nad kojima se ne vrši dovoljna kontrola.
U radu se također raspravlja o klasifikaciji invazivnih vrsta na temelju njihovog utjecaja. Istaknuta je Uredba Europske unije (EU) br. 1143/2014 koja ima za cilj spriječiti i upravljati unošenjem i širenjem invazivnih vrsta. Osnova te Uredbe je „Unijin popis“ o invazivnim stranim vrstama koje izazivaju zabrinutost u Europskoj Uniji pa tako i u Hrvatskoj. Vrste su kategorizirane u crnu, sivu i bijelu listu ovisno o razini opasnosti.
Proučavaju se primjeri invazivnih vrsta u Hrvatskoj uz detaljno objašnjenje njihovog podrijetla, načina unošenja i specifičnih ekoloških šteta koje uzrokuju. Rad naglašava važnost prepoznavanja i ublažavanja utjecaja invazivnih vrsta za očuvanje hrvatske autohtone bioraznolikosti i očuvanje ekološke ravnoteže.This paper, entitled " Invasive alien animal species in Croatia ", focuses on the ecological and economic effects of non-native invasive species introduced to Croatia, intentionally or accidentally. Invasive species, which include insects, mammals, fish, crabs, reptiles and birds, adapt quickly and more widely due to the lack of natural predators, endangering local biological diversity and disrupting ecosystems.
Various habitats in Croatia, from forests, rivers and lakes to coastal and mountainous areas, provide good living conditions for new species. Croatia's diverse climate and climate change further favors their survival and expansion. Human activities such as trade, tourism and transport also contribute to the spread of invasive alien species, with ports such as the one in Rijeka being significant entry points that are not sufficiently controlled.
The paper also discusses the classification of invasive species based on their impact. The European Union Regulation (EU) no. 1143/2014 aims to prevent and manage the introduction and spread of invasive species. The basis of that Regulation is the „Union's list“ of invasive alien species that cause concern in the European Union and in Croatia as well. Species are categorized into black, gray and white lists depending on the level of danger.
Examples of invasive species in Croatia are studied with a detailed explanation of their origin, method of introduction and specific ecological damage they cause. The paper emphasizes the importance of recognizing and reduction of the impact of invasive species for the preservation of Croatian indigenous biodiversity and the preservation of ecological balance
Decoding the Epigenetics of Infertility: Mechanisms, Environmental Influences, and Therapeutic Strategies
No full textInfertility is a complex condition caused by a combination of genetic, environmental, and lifestyle factors. Recent advances in epigenetics have highlighted the importance of epigenetic changes in fertility regulation. This review aims to provide a comprehensive overview of the epigenetic mechanisms involved in infertility, with a focus on DNA methylation, histone modification, and non-coding RNAs. We investigate the specific epigenetic events that occur during gametogenesis, with a focus on spermatogenesis and oogenesis as distinct processes. Furthermore, we investigate how environmental factors such as diet, stress, and toxin exposure can influence these epigenetic changes, potentially leading to infertility. The second part of the review explores epigenetic changes as therapeutic targets for infertility. Emerging therapies that modulate epigenetic marks present promising opportunities for fertility restoration, particularly in spermatogenesis. By summarizing current research findings, this review emphasizes the importance of understanding epigenetic contributions to infertility. Our discussion aims to lay the groundwork for future research directions and clinical applications in reproductive health
Surgical management of anastomotic leakage related to ovarian cancer surgery: a narrative review
No full textThis narrative review describes the state of the art in the management of anastomotic leakage in ovarian cancer. Multiple surgical procedures, including bowel resection, are often required to achieve “optimal” cytoreduction in locally advanced ovarian cancer. Intestinal anastomosis is currently the most common way to restore bowel continuity. However, in some patients, a temporary protective stoma is indicated to prevent anastomotic leakage. This is an important issue to improve surgical outcomes and until recently there has been a lack of objective data to clarify the risk factors for anastomotic leakage. This review describes the risk factors for AL associated with surgery and compares the results of recent studies. We also review the current indications for placement of a protective ileostomy and treatment options for conservative management of AL. We present two examples of practical clinical AL risk calculators, in addition to the most assessed AL risk factor. To date, the decision-making processes that lead surgeons to perform a protective ileostomy are quite heterogeneous and based on the personal experience of the surgeon, mainly depending on individual training. Three different management options after colorectal anastomosis in OC are described: conservative management, diversion ileostomy and ghost ileostomy
The Incidence of Scabies in the Primorje-Gorski Kotar County from 2012 to 2022.
No full textZarazna bolest kože uzrokovana parazitskom grinjom Sarcoptes scabiei poznata je pod nazivom scabies ili svrab. Ova bolest predstavlja značajan javnozdravstveni problem zbog svoje visoke zaraznosti i učestalosti u populaciji. Svrab se prenosi direktnim kontaktom s kože na kožu ili rijetko indirektnim kontaktom putem zaraženih predmeta. Bolest je raširena globalno, ali je češća u zajednicama s lošim sanitarnim uvjetima i većom gustoćom stanovništva. U ovom radu prikazana je incidencija svraba u Primorsko-goranskoj županiji u vremenskom razdoblju od 2012. godine do 2022. godine. Cilj rada je bio opisati osnovne biološke značajke parazitske grinje, etiologiju parazitiranja na čovjeku te najvažnije socijalne, ekonomske i javnozdravstvene implikacije scabiesa na pojedinca i zajednicu. U radu su korišteni javno dostupni podaci statističkog ljetopisa Primorsko-goranske županije te su uspoređeni sa podacima dostupnim iz drugih dijelova Republike Hrvatske. Obradom podataka vidljiv je porast incidencije u 2018. i 2019. godini te stanoviti pad tijekom pandemije bolesti COVID-19. Redovito provođenje epidemioloških studija, edukacija zdravstvenih djelatnika, ali i javnosti o pravovremenom prepoznavanju, liječenju i mjerama prevencije svraba ključan je korak za praćenje pojavnosti i kontrolu ove javnozdravstveno bitne parazitske grinje.An infectious skin disease caused by the parasitic mite Sarcoptes scabiei represents a significant public health problem due to its high contagiousness and frequency in the population. Scabies is transmitted by direct skin-to-skin contact or, rarely, by indirect contact through infected objects. The disease is widespread globally but is more common in communities with poor sanitation and higher population density. In this paper, the incidence of scabies in Primorje-Gorski Kotar County in the period from 2012 to 2022 is presented. The aim of the paper was to describe the basic biological features of the parasitic mite, the etiology of parasitism on humans and the most important social, economic and public health implications of scabies on the individual and the community. The paper uses publicly available data from the statistical yearbook of the Primorje-Gorski Kotar County and compares it with data available from other parts of the Republic of Croatia. Data processing shows an increase in incidence in 2018 and 2019 and a certain decrease during the COVID-19 pandemic. Regularly conducting epidemiological studies, educating health professionals and the public about the timely recognition, treatment and prevention measures of scabies is a key step in monitoring the occurrence and control of this parasitic mite, which is important for public health
ODREĐIVANJE LAKOHLAPIVIH AROMATSKIH UGLJIKOVODIKA U VODAMA
No full textZdravstveno ispravna voda je voda koja ne sadržava tvari koji imaju negativan utjecaj na ljudski
organizam. Vode za piće su za potrebe svog stanovništva te kvaliteta vode mora biti na visokoj
razini ne bi li se spriječila svaka potencijalna opasnost koja bi narušila ljudsko zdravlje.
Potrebno je pravilno i kontinuirano provoditi analizu vode te provjeravati ispravnost sustava za
kemijsku, biološku i fizikalnu obradu vode. Na taj način izbjegava se opasnost od pojave BTEX
spojeva u vodi. Lakohlapivi aromatski ugljikovodici (BTEX) su skupina organskih spojeva
karakterizirana visokom hlapljivošću i prisutnošću jednog ili više benzenskih prstenova u
njihovoj molekularnoj strukturi. Ovi su spojevi značajni zbog svoje široke primjene u industriji,
prisutnosti kao zagađivača okoliša i potencijalnog utjecaja na zdravlje. Učinkovito upravljanje
i regulacijske mjere bitne su za smanjenje njihovog ispuštanja i ublažavanja povezanih rizika.
Da bi se odredila prisutnost BTEX spojeva koristi se tehnika zvana kromatografija. Ona
odjeljuje, identificira i kvantitativno određuje kemijske sastojke u vodi. Metoda kojim se
određuju BTEX spojevi je plinska kromatografija U ovom radu nastoji se odrediti prisutnost
benzena koji je glavni predstavnik BTEX spojeva u vodama za piće. Određuju se plinskom
kromatografijom preko MS i FID detektora.Healthy water is water that does not contain substances that have a negative impact on the
human body. Drinking water is for the needs of its population, and the quality of the water must
be at a high level in order to prevent any potential danger that would harm human health. It is
necessary to properly and continuously conduct water analysis and check the correctness of the
system for chemical, biological and physical water treatment. In this way, the danger of the
appearance of BTEX compounds in the water is avoided. Volatile aromatic hydrocarbons
(BTEX) are a group of organic compounds characterized by high volatility and the presence of
one or more benzene rings in their molecular structure. These compounds are significant due to
their wide application in industry, presence as environmental pollutants and potential health
impact. Effective management and regulatory measures are essential to reduce their release and
mitigate associated risks. A technique called chromatography is used to determine the presence
of BTEX compounds. It separates, identifies and quantitatively determines the chemical
components in water. The method used to determine BTEX compounds is gas chromatography.
This work aims to determine the presence of benzene, which is the main representative of BTEX
compounds in drinking water. They are determined by gas chromatography using MS and FID
detectors
The endocannabinoid system in appetite regulation and treatment of obesity
No full textThe endocannabinoid system (ECS) is a complex cell-signaling system that is responsible for maintaining homeostasis by modulating various regulatory reactions in response to internal and environmental changes. The influence of ECS on appetite regulation has been a subject of much recent research, however, the full extent of its impact remains unknown. Current evidence links human obesity to ECS activation, increased endocannabinoid levels in both central and peripheral tissues, along with cannabinoid receptor type 1 (CBR1) up-regulation. These findings imply the potential pharmacological use of the ECS in the treatment of obesity. Here, we present various pathophysiological processes in obesity involving the ECS, highlighting different pharmacological options for modulating endocannabinoid activity to treat obesity. However, the potential of those pharmacological possibilities remains under investigation and requires further research